Heparin surface coating is a convenient means of improving the thrombo resistance of blood-exposed surfaces. At this time, heparin can be bonded to oxygenator/heat-exchanger structures, soft venous reservoirs, cardiotomy reservoirs, centrifugal pump heads, tubings, and cannulae. Following experimental evaluation, these devices have become available for clinical application. Cardiopulmonary bypass with low or no systemic heparinization can be realized in selected cases. Improved haemostasis in combination with modification of standard surgical techniques results in limited blood loss and reduced transfusion requirements and appears to be the main benefit of cardiopulmonary bypass with heparin-bonded surfaces. Experience using heparin- bonded equipment in various clinical situations is reviewed.
Get full access to this article
View all access options for this article.
References
1.
Müller-Glauser W., Lehmann KH, Bittmann P. et al. A compliant small-diameter vascular prosthesis lined with function venous endothelial cells. Trans Am Soc Artif Intern Organs1988; 34: 528-31.
2.
Dasse KA, Chipman SD, Sherman CN et al. Clinical experience with textured blood contacting surfaces in ventricular assist devices. Am Soc Artif Organs J1987; 10: 418-25.
3.
Josefowicz M. , Jozefonvicz J.New approaches to anticoagulation heparin like biomaterials. Am Soc Artif Organs J1985 ; 8: 218-22.
Cukingnan RA , Fee HJ, Carey JSRepair of lesions of the descending thoracic aorta with the TDMAC-heparin shunt. J Thorac Cardiovasc Surg1978 ; 75: 227-31.
6.
Kim SW, Ebert CD, Lin JY et al. Nonthrombogenic polymers. Pharmaceutical approaches. Am Soc Artif Organs J1983; 6: 76-87.
7.
Larm O., Larsson R., Olsson P.A new nonthrombogenic surface prepared by selective covalent binding of heparin via a modified reducing terminal residue. Biomater Med DevicesArtif Organs1983; 11: 161-73.
8.
Tong SD, Rolfs MR, Hsu LCEvaluation of Duraflo II heparin immobilized cardiopulmonary bypass circuits . Trans Am Soc Artif Intern Organs1990; 36: M654-6.
9.
von Segesser LK, Weiss BM, Turina MIPerfusion with heparin-coated equipment: potential for clinical use. Semin Thorac Cardiovasc Surg1990; 2: 373-80.
10.
von Segesser LK, Lachat M., Gallino A. et al. Superior hemodynamics in left heart bypass without systemic heparinization. Eur J Cardiothorac Surg1990; 4: 384-9.
11.
von Segesser LK, Lachat M., Gallino A. et al. Performance characteristics of centrifugal pumps with heparin surface coating. Thorac Cardiovasc Surg1990; 34: 224-8.
12.
von Segesser LK, Weiss BM, Bisang B., Leskosek B., Turina MIVentricular assist with heparin surface coated devices. Trans Am Soc Artif Intern Organs1991; 37: H278-9.
13.
von Segesser LK, Turina MIHeparin coated hollow fiber membrane oxygenator without systemic heparinization in comparison to classic membrane and bubble oxygenators. J Extracorp Technol1988; 76-80 (Proceedings issue).
14.
von Segesser LK, Turina M.Cardiopulmonary bypass without systemic heparinization: performance of heparin coated oxygenators in comparison with classic membrane and bubble oxygenators. J Thorac Cardiovasc Surg1989; 98: 386-96.
15.
von Segesser LK, Turina M.Long term cardiopulmonary bypass without systemic heparinization. IntJArtif Organs1990; 13: 687-91.
16.
von Segesser LK, Lachat M., Leskosek B. et al. Cardiopulmonary bypass with low systemic heparinization: an experimental study. Perfusion1990;5:267-76.
17.
von Segesser L.Perfusion in descending thoracic aortic aneurysms . Eur J Cardio-Thorac Surg1992; 6: 246-50.
18.
von Segesser LK, Weiss BM, Garcia E., von Felton A., Turina M.Reduction and elimination of systemic heparinization during cardiopulmonary bypass. J Thorac Cardiovasc Surg1992; 103: 790-9.
19.
von Segesser LK, Weiss BM, Leskosek B., von Felten A., Pei P., Turina M.Experimental evaluation of heparin coated cardiopulmonary bypass equipment with low systemic heparinization and high-dose aprotinin. Thorac Cardiovasc Surg1991; 39: 251-6.
20.
von Segesser LK, Garcia E., Turina MILow-dose heparin versus high-dose aprotinin during cardiopulmonary bypass. Texas Heart Inst J1993 (in press).
21.
Royston D., Bidstrup B., Taylor K., Sapsford R.Effects of aprotinin on need for blood transfusion after repeat open heart surgery. Lancet1987; ii: 1289-91.
22.
Harder MP, Eijsman L., Roozendahl KJ, Van Oeveren W., Wildevuur Crh.Aprotinin reduces intraoperative and postoperative blood loss in membrane oxygenator cardiopulmonary bypass. Ann Thorac Surg1991; 51: 936-41.
23.
von Segesser LK, Weiss BM, Hänseler E. et al. Improved biocompatibility of heparin surface-coated ventricular assist devices. IntJArtif Org1992; 15:301-6.
24.
von Segesser LK, Pasic M., Leskosek B., Garcia E., Turina M.Heparin coated cardiotomy reservoirs with improved thromboresistance: experimental evaluation ex vivo. Cah CECEC1991; 36: 9-16.
25.
von Segesser LK, Pasic M., Olah A., Leskosek B., Garcia E., Turina M.Performance characteristics of hemofilters with heparin surface coating: an experimental study. J Extracorp Technol1992; 24: 81-85.
